State Exchange Situations Vary at Start of Open Enrollment

Things seem to be going better overall, at least during the first few days.

WASHINGTON -- As open enrollment begins this week for health insurance plans in exchanges run by the states and the federal government, patients and providers alike are waiting to see whether this second year of the exchanges will proceed more smoothly than the first year.

Last year's rollout of the exchange run by the federal government was a disaster, plagued by long waits, computer crashes, and lack of clarity about which networks included which providers. The Department of Health and Human Services vowed to do better this year.

So far, this year's open enrollment seems to be proceeding much more smoothly in both state-run exchanges and the federal exchange, according to news reports. More than 100,000 people signed up online for insurance on Saturday, the first day that many exchanges were open.

Meena Seshamani, MD, director of the Office of Health Reform at the Department of Health and Human Services, said the Obama administration learned some important lessons about outreach from last year's open enrollment.

The 13 exchanges run by the states and the District of Columbia had varying levels of success during their first season, with many hoping for improvements in enrollment this time around. Here is a snapshot of how things are going in a few states:

Maryland. The rollout of Maryland's website in October 2013 was a mess, possibly contributing to a failed gubernatorial bid by Maryland Lieutenant Gov. Anthony Brown (D), who was put in charge of the exchange implementation by Gov. Martin O'Malley (D). As of early March 2014, the exchange, which was plagued by computer problems, had enrolled only 39,000 Marylanders, according to news reports.

In December 2013, the exchange's original director, Rebecca Pearce, resigned. In late February 2014, the state fired its contractor, Noridian Healthcare Solutions, and hired Optum/QSSI to help fix the website. Because of all the problems, a congressman from Maryland, Rep. Andy Harris (R), requested that the Office of Inspector General at the Department of Health and Human Services launch an audit of the exchange; Harris said in August that the audit "had moved into a full-blown investigation" and that the OIG had begun issuing subpoenas.

Maryland officials considered switching from the state-run exchange to the federal government's exchange, but ultimately decided that doing so would not meet residents' needs. Instead, they announced in late March 2014 that they would be adopting the exchange platform developed by the state of Connecticut.

The revamped exchange launched an "anonymous browsing" feature -- in which consumers could look at various plan options and financial details without putting in personal information -- on Nov. 8, a day ahead of schedule. Online enrollment for the exchange is slated to begin on Wednesday.

New York. New York state was pleased with the way its open enrollment went last year, according to Donna Frescatore, executive director of New York State of Health, the state's health insurance exchange.

"By April 15, when we closed open enrollment, we'd enrolled nearly a million New Yorkers across all programs in the marketplace," including Medicaid and Child Health Plus, New York's version of the Children's Health Insurance Program, Frescatore told MedPage Today in a phone interview, during which a public relations person sat in on the call. Of the 960,762 enrollees, 370,604 were enrolled in qualified private health plans, with the rest in Medicaid and Child Health Plus, she said.

That isn't to say the first year wasn't without any problems. When the site opened on Oct. 1, 2013, "in the first couple of hours we had millions of website hits," said Frescatore. "As a result, some people on the website found it was moving too slowly, while others might have been blocked from accessing the website."

But by the following Saturday, 4 days later, the state had quadrupled the processing capacity of the system, she continued. "We had sized it for high volume, but the volume of response we had was more than anyone would have reasonably expected."

Since then, the exchange website has functioned smoothly, according to Frescatore. "The average time to move from one page to another is 2.5 seconds," she said. As for phone calls, there have been a few times during which volume has been significant, "particularly around the cutoff of Jan. 1 and at the end of March."

To make things easier for consumers this year, New York -- like many other states -- sent re-enrollment notices to the households that were already enrolled in a plan; those who don't want or need to change their current health plans don't have to do anything, and they will be automatically re-enrolled.

"One lesson we learned last year is that even with standardized plans, making a decision about what plan you enroll in is complicated," said Frescatore. To assist with the decision, the site is debuting two new tools -- a "plan compare" guide which allows users to compare plans that are available in the county in which they live, and an "anonymous shopping" feature similar to Maryland's.

Connecticut. Unlike Maryland or the federal government, Connecticut's exchange rollout went quite smoothly. By the third day of operation, Connecticut's Access Health CT had had more than 82,000 visitors to its website, handled over 5,000 calls, and processed 753 applications. A customer satisfaction survey found that 82% of those using the state's website were "'extremely likely' and 'very likely' to recommend Access Health CT to a friend or colleague," the exchange announced at the end of October 2013.

This year the state began the enrollment season by mailing renewal "tool kits" to exchange users who are already in a qualified health plan; nearly 44,000 people are eligible for "auto-renewal" status and will not have to do anything in order to keep their coverage, according to an exchange press release.

Modest Success Overall

In terms of plan signups, Connecticut and Maryland had similar success by the time open enrollment ended last year: in Connecticut, 113,000 were deemed eligible for enrollment in a marketplace plan and about 79,000 selected a plan (70%), while in Maryland, 99,000 were deemed eligible and 68,000 selected a plan (69%). New York's numbers were a bit lower: in that state, a total of 707,000 individuals were deemed eligible but only 370,000, or 52%, actually selected a plan. (See accompanying infographic.)

At the briefing Friday, Timothy Jost, JD, the Robert L. Willett Family Professor of Law at Washington and Lee University in Lexington, Va., predicted that things would have to go better this year compared with last year in at least one state: Oregon. That's because Oregon's state-based exchange was such a fiasco last year that the state gave up and defaulted to the federal exchange.

"I think there are some states where we'll clearly see improvement, but we'll have to see," he said.

Despite the problems on various exchanges last year, most consumers -- on and off the healthcare exchanges -- are satisfied with their current health plans, according to an online survey conducted in early November prior to open enrollment by Healthline, a healthcare technology company.

Nearly 77% of 420 respondents said they were satisfied with their current health insurance plan, with the majority (56.5%) finding the deductible in their current plan reasonable or inexpensive, the company said in a press release.

Among those who enrolled in plans through the ACA's health insurance exchanges, nearly 84% were satisfied with their current plan, the survey found. Only 9% planned to switch to a different plan during the upcoming open enrollment season.

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